AIDS Healthcare Foundation

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Risk Adjustment Analyst

Risk Adjustment Analyst

Req No 
2017-6974
Job Locations 
US-CA-Los Angeles
Category 
Corporate
Type 
Regular Full-Time

More information about this job

WHO WE ARE

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

 

Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

 

If so, AIDS Healthcare Foundation is the place for you!

 

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

  

AHF’s core values are to be:

 

• Patient-Centered

• Value Employees

• Respect for Diversity

• Nimble

• Fight for What’s Right

 

 

STILL INTERESTED? Please continue!

YOUR CONTRIBUTION TO OUR SUCCESS!

Includes the following. Other duties may be assigned.

 

Under general supervision of the Chief Information Officer and Associate Director of Data and Information Architecture, Information Technology, this individual will perform the following activities:

 

Analyze health management programs including: data collection, validation and outcome measurement. May include:

 

Financial, pharmacy, claims, provider, and member datao IRS, CMS, HHSC, HEDIS reportingo Internal data cleansing and data reconciliation analysiso Trend analysis in various functional areas of health care management.conduct research on Medicare and Medicaid claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and support ongoing fraud investigations and requests for data

 

Create and generate reports through SQL using Business Objects interface and direct links to core databases.

 

Provide timely analysis of risk adjustment outcomes and participate in the development of new risk adjustment opportunities.

 

Support initiatives related to informing program direction, program results, key analytics and actionable reports to physician groups

 

Develop and manage reporting of risk adjustment department dashboard, metrics and program results.

 

Provide analytics and reports to constituent departments to inform financial plans, forecasts and annual bids.

Collect, analyze and synthesize data; develop information and reporting to guide business decision making for risk adjustment activities and revenue optimization strategies.

 

Design, build and enhance database systems for complex high level reporting requirements

Critically review results of analytics to make recommendations on process improvements, vendor remediation, changes to strategic approaches, etc

 

Monitor related guidance and keep relevant stakeholders informed

 

Partner closely with internal business partners, directors and managers, such as Health Care Coordination, Product Management, Provider Contracting, Legal and IT regarding the results of multiple risk adjustment initiatives.

 

Interact with all departments, maintain effective team relationships and share best practices with Operations leaders and associates.

 

Demonstrate loyalty, integrity and professionalism.

Foster a team-based environment by participating in projects and activities that support the goals of the team.

 

Develop a strong analytic team, encouraging career and developmental growth, and provide leadership support to analysts and others in Risk Adjustment department.